j:8xasasasososfxxosixososci^^ 


CERTAIN  ASPECTS 


OF 


PUBLIC  MATERNITY  AND 
INFANT  CARE 


IN 


BERLIN  AND  STOCKHOLM 


BY 


ELIZABETH  PINNEY  HUNT 


CERTAIN   ASPECTS 


OF 


Public  Maternity  and  Infant  Care 


IN 


BERLIN  AND  STOCKHOLM 


ic  ^^ 


By 

ELIZABETH  PINNEY  HUNT,  A.  B.,  M.  A. 

Bryn  Mawr  College 

FelloNA/,  American  Scandinavian  Foundation, 
University  of  Stockholm,  1920^2 1 


^^ 


CONTENTS 


Introduction. 
General  Organization. 


PART  I. 


MATERNITY  CARE. 

Department  of  Public  Guardianship. 
Maternity  Hospitals. 


PART  II. 


INFANT  CARE. 

Municipal  Clearing  House  for  Foster  Children. 

Departments  of  Public  Guardianship. 

Clinics  and  Milk  Stations. 

Children's  Hospitals. 


Kft 


Deaths  from  Diseases  due  to  Pregnancy  and 
Confinement,  1910 

Rate  per  1000  Live  Births  Rate  from  puerperal  septicemia 

„          ,       .                                _  ^  per  1,000  live  births 

Pennsylvania 7.1  Pennsylvania 3-2 

France 4.6  France   2  2 

New  Zealand 4.5  ^^^  Zealand L3 

England 3.6  England 1.4 

Germany 3.2  Germany 1.4 

Sweden 25  Sweden .9 

Maternal  Mortality,  1910 

Rate  of  deaths  per  1000  live 
births 


Rate  of  deaths  from  puerperal 
septicemia  per  1,000  live  births 


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Source:  Compiled  from.  Official  Sources. 


Introduction 


The  problem  of  how  best  to  care  for  mothers  and  infants 
has  been  before  the  American  public  during  the  past  few  years. 
The  work  along  these  lines  done  by  the  Federal  Children's 
Bureau  and  the  recent  enactment  of  the  Sheppard-Towner  bill 
providing  for  Federal  and  State  Maternity  Care,  have  done, 
perhaps,  most  to  arouse  discussion  of  the  scope  of  public  respon- 
sibility. Many  charts  have  been  drawn  showing  how  far  behind 
America  stands  in  comparison  with  other  countries  in  respect 
to  maternity  and  infant  mortality.  The  trend  seems  to  be,  defi- 
nitely, to  arouse  a  sense  of  responsibility  for  these  unnecessary 
deaths  on  the  part  of  those  who  are  professionally  engaged  in 
maternity  and  infant  care,  as  well  as  on  the  part  of  the  general 
lay  public. 

A  study  of  the  characteristic  public  work  carried  on  in  two 
large  cities  of  two  of  the  countries  showing  low  maternity  and 
infant  death  rates,  may,  therefore,  prove  timely.  As  it  has  been 
possible  to  observe  personally  various  aspects  of  the  public  work 
for  maternity  and  infant  care  in  Berlin  and  Stockholm,  a  de- 
scription of  such  work  in  these  two  cities  will  be,  perhaps,  valua- 
ble. 

Where  gaps  occur  in  facts  and  statistics,  allowance  must  be 
made,  in  the  case  of  Germany,  for  a  natural  reticence  due  to  in- 
ternational conditions  since  the  war.  Furthermbre,  the  German 
institutions  have  not  had  sufficient  funds  in  many  cases  to  tabu- 
late and  print  their  more  recent  data.  In  Stockholm  this  lat- 
ter difficulty  did  not  exist. 

It  must  be  remembered  that  both  foreign  studies  are  de- 
scriptive only  of  the  conditions  found  at  the  time  the  surveys 
were  made.  In  Berlin  the  survey  took  place  in  January,  1921, 
in  Stockholm,  in  November,  1920. 

The  writer  has  confined  the  study  to  institutions  personally 
visited,  and  has  made  no  attempt  to  pass  judgment  on  the  med- 
ical aspect  of  the  problems  involved.  The  purpose  of  the  short 
study  is  to  present  a  fair  picture  of  the  outstanding  public  re- 
sources for  maternity  and  infant  welfare  in  Berlin  and  Stock- 
holm, and  of  the  organization  of  the  administration  of  these  re- 
sources. It  is  the  social,  not  the  medical  problem  that  is  de- 
scribed. 


PUBLIC  MATERNITY  AND  INFANT  CARE 
IN  BERLIN  AND  STOCKHOLM 


The  statistics  relating  to  maternity  mortality  in  the  United 
States  and  several  of  the  larger  countries  in  Europe  reveal  a 
marked  difference  in  favor  of  Europe,  It  is  possible  that  this 
difference,  while  due  to  many  causes  of  race,  adaptation  to  en- 
vironment, and  different  modes  of  living,  may  be  due  in  part, 
to  a  superior  organization  of  the  factors  involved  in  the  social 
supervision  of  maternity  and  infant  care. 

Maternal  {Mortality  Rates  in  the  United  States  and  Certain  Foreign 
Countries  per  1.000  Live  Births 

Uruguay  (1919)  2.3 

Italy  (1916)  2.7 

Sweden  (1916)  2.7 

Norway  (1917)  3.0 

The  Netherlands  (1919)  '                  3.4 

Japan  (1918)  3.8 

Hungary  (1915)  4.0 

England  and  Wales  (1919)  4.4 

Finland  (1918)  ,,                  4.4 

Ontario  (1919)  '                  4.5 

Ireland  (1919)                             ,  4.7 

German  Empire  (1918)  4.9 

Australia  (1920)  5.0 

Spain  (1915)  5.2 

Switzerland  (1915)  5.5 

France  (1914)  5.7 

Scotland  (1919)  6.2 

New  Zealand  (1920)  6.5 

U.  S.  Birth  Registration  Area,  1919)  7'.4 

Chile  (1919)  8.8 

Source:  Compiled  from  official  sources  or  from  Annuaire 
International  de  Statistique,  by  the  Federal  Children's  Bureau 
Latest  figures  available,  January  1,  1922. 


Public  Maternity  and  Infant  Care 

Before  discussing,  separately,  types  of  the  public  institu- 
tions in  Berlin  and  Stockholm  which  deal  most  prominently 
with  maternity  care  and  infant  care,  it  will  ibe  necessary  in  each 
city  to  give  a  brief  outline  of  the  general  organization  covering 
the  two  closely  allied  divisions  of  work. 

The  public  work  in  Greater  Berlin  for  the  protection  of 
needy  mothers  and  infants  is  covered  by  State,  Provincial  and 
Municipal  institutions,  and  by  those  that  are  private,  with 
grants-in-aid  from  Republic,  Province,  State,  or  Municipality. 
With  two  exceptions  the  work  described  in  Berlin  will  be  con- 
fined to  municipal  institutions. 

The  municipal  work  in  Greater  Berlin  falls  under  the  super- 
vision of  two  city  departments,  (1)  The  Department  for  Chil- 
dren, and  (2)  The  Municipal  Board  of  Health.  The  municipal 
department  of  greatest  interest  is  the  Department  for  Children, 
which  was  founded  only  as  long  ago  as  1919,  and  is,  at  present, 
undergoing  a  process  of  change.  It  represents  an  effort  to  cen- 
tralize the  work  done  for  mothers  and  children  and,  in  its  new 
plan,  which  has  passed  the  Municipal  Deputation  for  the  Wel- 
fare of  Youth,  and  is  about  to  be  passed  by  the  Municipal  Coun- 
cil, it  advances  far  in  the  direction  of  satisfactory  centralization. 

The  general  scope  of  the  work  of  the  Department  for  Chil- 
dren, as  now  planned,  may  be  summarized  briefly. 

The  Central  Department  for  Children  of  Berlin,  is  com- 
prised of  three  departments : — 

I.  General  Division,  which  deals  with  Organization  and  In- 
formation and  is  located  at  33  Altejacobstrasse. 

II.  Child  Care  and  'Guardianship,  which  is  divided  into: — 

1.  Division  for  Child  Welfare,  with  headquarters  at 
33  Altejacobstrasse,  and  consists  of  four  divisions: — 

(a)  Preventive  Care  for  Children,  which  deals  with 
the  Stations  for  the  Care  of  Small  Children,  Day  Nurseries, 
Children's  Houses,  Foster  Children,  and  Crippled  Children; 

(b)  Welfare  Work  which  arises  in  Connection  with 
the  Police,  such  as  cases  of  homeless  juveniles,  and  girls  in 
moral  danger; 

(c)  Care  of  Children  Educated  Outside  of  the  Family 
Group ; 

(d)  Care  for  Delinquent  Children. 

2.  Division  of  Public  Guardianship,  with  headquarters 
at  43  Landsbergerstrasse.     The  Division  of  Public  Guardianship, 

8 


Public  Maternity  and  Infant  Care 

founded  in  1912,  and  enlarging  its  field  in  1921,  has,  in  general, 
for  its  scope : 

(a)  The  supervision  of  all  needy  children,  whose  par- 
ents are  either  inadequate  or  deceased; 

(b)  Pre-natal  and  maternity  care; 

(c)  Professional  care  for  illegitimate  children'; 

(d)  "Work  connected  with  the  adoption  of  children; 

(e)  Legal  work  arising  in  connection  with  its  afore- 
mentioned duties. 

III.  Department  for  Child  Kecreation,  with  an  office  oii 
Neuefriedrichstrasse,  covers  the  work  done  by  the  city  for  chil- 
dren's playground,  gymnastics,  theatres,  music,  etc. 

The  Central  Department  for  Children  is  reproduced  in  each 
of  the  twenty  districts  of  Greater  Berlin.  In  each  district  is  the 
District  Station,  which  acts  as  a  bureau  of  information  for  the 
inhabitants  of  the  district,  and  from  which  investigators  work. 
The  central  office  has  final  jurisdiction  over  all  cases. 

The    Municipal    Health    Department    touches   the    work    for 
mothers  and  infants  in  two  of  its  departments : — 

1.  The  Department  of  Hospitals. 

2.  The  Department  of  Social  Hygiene. 

These  two  departments  exist  for  Greater  Berlin.  Each  of 
the  twenty  districts  of  Greater  Berlin  has  for  itself  a  Health 
Division,  whose  function  is  to  fulfill  the  orders  of  the  central 
Health  Department. 

The  Department  of  Hospitals,  has,  as  the  name  indicates, 
the  entire  supervision  of  Municipal  Hospitals,  including  those 
for  women  and  infants.  The  department  of  Social  Hygiene  is 
engaged  in  so  far  as  it  touches  our  subject,  in  the  supervision  of 
medical  work  in  the  various  homes  and  institutions  for  mothers 
and  babies — as  the  medical  work  in  the  Public  Orphan  Home 
and  in  the  Stations  for  the  Care  of  Infants. 

Under  the  first  department,  the  Department  of  Hospitals 
are  the  three  large  municipal  houses  for  maternity  and  infant 
care: — The  City  Maternity  Hospital,  The  Municipal  Home  for 
Children  and  Mothers,  and  Kaiser  and  Kaiserin  Friedrich'a 
Childrens'  Hospital. 

Turning  now  to  the  general  plan  of  the  public  work  for 
mothers  and  infants  in  Stockholm,  a  contrast  at  once  is  obvious 
in  com^parison  to  Berlin.  The  organization  in  Stockholm  tends 
more  to  decentralization.     In  several  features,  however,  the  in- 

9 


Public  Maternity  and  Infant  Care 

stitutions  are  much  alike,  though  operated  under  different  auth- 
orities. The  public  work  carried  on  may  be  classified  into  that 
falling  under  (1)  The  State  Health  Department;  (2)  The  Muni- 
cipal Board  of  Health;  (3)  The  State  Social  Department,  which 
covers  the  work  of  the  Board  for  Child  Welfare  similar  to 
the  Berlin  Department  of  Public  Guardianship  and  the  work  of 
the  Poor  Law  Authority,  which  is  not  now  of  importance  in  Ber- 
lin. Grants-in-aid,  as  in  Berlin  are  given  by  the  State  to  var- 
ious private  institutions.  The  institutions  in  Stockholm^  may  be 
grouped,  for  clearness,  as  below.  •  It  is  obvious  that  work  cov- 
ered by  municipal  organization  in  Berlin,  is  under  State  auth- 
ority in  Stockholm. 

I.  State  Department  of  Health 
1.     General  Maternity  Hospital. 

II.  Mknicipal  Board  of  Health 

1.  South  Municipal  Maternity  Hospital. 

2.  Sachs  Baby  Hospital. 

3.  Bureau  for  the  Care  of  Foster  Children. 

III.     State  Social  Department 

1.  Bureau  for  Child  Care. 

2,  Poor  Daw  Board. 

(a)  Municipal  Infant  Home. 

(b)  The  Municipal  Home  for  Children  at  Asogaten. 
The  above  outline  of  the  organization  of  the  most  important 

public  work  for  maternity  and  infant  care  in  Berlin  and  Stock- 
holm, leads  to  a  closer  examination  of  particular  institutions  re- 
lating first  to  maternity  care  and  secondly  to  infant  care. 


10 


PART  I.— MATEPvNITY  CARE 
Department  of  Public  Guardianship 

The  Department  for  Public  Guardianship,  already  men- 
tioned, as  a  division  of  the  ]\Iunicipal  Department  for  Children, 
is  the  outstanding  feature  of  the  public  work  in  Berlin  for 
mothers.  It  touches  the  work  of  maternity  care  in  its  division 
for  pregnancy  and  confinement.  The  course  of  action  oc- 
curs somewhat  as  follows:  Women  who  are  pregnant  and  find 
need  of  assistance  that  their  families  are  unable  to  provide,  may 
apply  for  aid  to  the  Department  of  Public  Guardianship.  All 
cases  must  go  through  t)his  central  office.  The  story  of  the 
woman  is  heard,  and  she  is  then  advised.  Usually  she  is  sent 
to  a  hospital  for  advice  or  prenatal  care,  or  if  the  confinement 
is  due  to  occur  within  eight  weeks,  she  may  enter  a  hospital  as 
a  working  patient.  After  childbirth  s^he  may  remain  in  the 
ward  ten  days,  after  which  period  she  must,  in  most  cases,  find 
other  accommodation.  If  the  mother  is  to  be  confined  at  her 
home,  the  Division  for  Public  Guardianship  provides  her  with 
all  the  necessary  articles  for  her  illness,  and  in  all  cases  gives 
the  infant's  layette.  All  needy  pregnant  women  may  re- 
ceive from  the  Division  for  Public  Guardianship  for  three 
months  before  confinement,  a  certain  amount  of  free  milk  daily. 
Leaflets  describing  proper  care  during  pregnancy,  as  well  as 
proper  care  for  the  infants,  are  circulated  among  the  applicants 
for  help.  A  list  of  hospitals  which  the  Division  for  Public 
Guardianship  may  call  upon  for  beds  is  kept  on  hand.  In  each 
hospital  there  are  from  twenty  to  one  hundred  beds. 

The  Division  for  Public  Guardianship  gives  money  in  cases 
of  stress  and  money  also  goes  to  confined  women  from  two  other 
sources,  (1)  The  Public  Sick  Fund,  to  which  all  persons  whose 
family  income  is  no  more  than  10,000  marks  a  year  may  be- 
long.*    Each  member  pays  a  small  sum  per  month,  and  the  State 

*Forei^  Exchange  Rates — New  York  on  Berlin  and  New  York  on 
Stockholm  for  a  7-year  period.     Nominal     Exchange    quotations    for 
checks  furnished  by  Brown  Bros.  &  Co.,  Phila. 
NEW  YORK  ON  BERLIN: 

1915    1916    1917    1918    1919    1920    1921 

.2225   .1918   .1766    0895   -0225   .0140 

1  Mark     i  iMark  1  Mark  1  JVIark  1  Mark  1  Mark 

NEW  YORK  ON  STOCKHOLM: 

.2537         .2787         .2962         .335         .2925         .2175         .2037 

1  Crown     1  Crown  1  Crown  1  CroA\m  1  Crown  1  Crown  1  Crown 

"All  of  the  above  quotations  are  for  a  date  in  January  in  each 

year  with  the  exception  of  the  New  York  on  Berlin  for  1917  and  1913 

which  records  for  January  are  not  available."     (Brown  Bros-  &  Co.) 

11 


Public  Maternity  and  Infant  Care 

pays  a  definite  lump  sum.  Confined  women  who  are 
members  are  entitled  to  18  marks  a  day  for  ten  days  after  child- 
birth. Most  of  the  hospitals  charge  a  small  sum  per  day,  which 
may,  then,  come  out  of  the  Public  Sick  Fund.  (2)  The  second 
source  of  income  to  confined  women  appears  through  the  Moth- 
ers' Confinement  Pension  Bill  which  appeared  in  Germany  dur- 
ing the  war,  (September,  1919).  The  main  features  of  the  bill 
are  necessary  to  an  understanding  of  its  provisions. 


National  Confinement  Pensions 

Main  Features — As  Issued  by  the  Department  of  Public  Guardianship. 

A — Help  in  Child  Bed 

1.  It  exists  for  the  woman  in  child  bed,  who,  for  at  least 
six  months  prior  to  her  confinement,  has  been  insured  by  the 
National  Pension,  as  well  as  by  a  legal  Sick  Fund  Benefit,  or  by 
a  Sick  Fund  of  a  Friendly  Society  against  illness. 

2.  It  exists  for  her  in  the  following  ways : — 

(A)  As  a  contribution  toward  the  cost  of  confine- 
ment to  be  paid  in  a  lump  sum,  at  one  time^  from  50  marks 
up; 

(B)  As  money  for  child  bed  above  the  Sick  Fund 
IMoney — and,  at  least  1  1-2  marks  daily  including  Sundays 
and  Holidays  for  ten  weeks;  of  which  four  shall  fall  in  the 
time  before  and  six  in  the  time  after  confinement.  The 
money  for  child  'bed  for  the  first  four  weeks  is  due  on  the 
day  of  confinement; 

(C)  As  a  money  grant  of  25  marks  for  the  services 
of  midwife  and  doctor,  in  case  such  should  be  needed  for 
the  delivery; 

(D)  As  a  nursing  premium,  as  long  as  the  woman 
nurses  her  new-born  infant,  to  the  amount  of  half  of  her 
Sick  Fund  Benefit  money  or  more^ — but  at  least  75  pfennig 
daily,  inclusive  of  Sundays  and  Holidays,  as  long  as  twelve 
weeks  after  confinement.  If  a  woman  should  die  in  con- 
finement, or  during  the  period  of  her  convalescence,  the 
payments  of  the  National  Mothers'  Pensions  shall  still  be 
due,  and  shall  be  paid  to  whomsoever  is  in  charge  of  the 
child. 

12 


Public  Maternity  and  Infant  Care 

3.  The  person  will  be  paid  through,  the  Sick  Fund  Bene- 
fit, to  which  the  woman  belongs. 

Help  in  Child  Bed  for  Uninsured  Women 
1,     It  will  protect  the  uninsured  wives,  daughters,   step- 
daughters, and  foster  daughters  of  insured  men,  who  live  in  the 
same  household. 

1st.     If  their  residence  is  in  Germany. 
2nd.     If  they  have  no  claim  on  the  assistance  for  child 
bed,  (for  example,  according  to  A.  I.) 

3rd.  And  if  the  insured  men  have  been  insured 
against  sickness,  not  less  than  six  months  prior  to  the 
woman's  confinement. 

The  conditions  on  which  said  woman  shall  receive  the  pen- 
sion are  practically  the  same  as  in  A-2.  It  shall  be  taken  care 
of  by  the  Sick  Fund  Benefit  to  which  the  male  relative  belongs. 

Care  in  Child  Be3d 

1.  It  exists  for  German  women  of  small  means  in  child 
bed  who  have  their  residence  in  Germany,  and  who  deserve 
Help  in  Child  Bed,  neither  as  insured  women  or  as  uninsured 
women  related  to  insured  men.     By  small  means  is  meant: — 

(A)  A  married  woman  in  child  bed,  whose  total  in- 
come, combined  with  her  husband's  during  the  year  or  the 
tax  year  prior  to  the  confinement,  has  not  exceeded  the  sum 
of  4,000  marks.  This  sum  may  be  increased  for  each  exist- 
ing child  under  fifteen  years  by  500  marks. 

(B)  An  unmarried,  or  lone  woman  in  child  bed,  if  her 
total  income  in  the  year  or  tax  year  prior  to  confinement 
has  not  exceeded  the  sum  of  4,000  marks.  This  sum  may 
be  increased  for  each  existing  child  under  fifteen  years  by 
500  marks. 

2.  The  conditions  of  payment  are  practically  the  same  as 
in  A-2. 

This  carefully  classified  bill  for  help  in  confinement  and 
nursing  is  designed  to  bring  relief  of  a  constructive  nature  (1) 
to  women  of  limited  income  who  have  taken  the  precaution  to 
insure  themselves;  (2)  to  women  of  a  limited  income  whose  male 
relatives  have  insured  themselves;  (3)  to  women  of  small  income 
who  have  no  claim  on  insurance  either  through  themselves  or 
their  male  relatives.  It  does  not  omit,  therefore,  destitute 
cases,  and  it  stimulates  women  of  small  income  to  insure  them- 
selves.    It  relieves  men  of  limited  income  who  look  ahead  far 

13 


Public  Maternity  and  Infant  Care 

enough    to    insure    themselves,    by    assisting  their    dependents 
through  confinement. 

(Stockholm  possesses  no  such  pension  system.  Furthermore, 
the  Board  for  Child  Welfare  in  Stockholm  has  no  division 
which  takes  care  of  pregnancy  and  confinement  as  does  the 
Berlin  Department  for  Public  Guardianship.  The  similarity  of 
these  two  Boards  lies  in  their  work  for  illegitimate  infants, 
which  will  be  discussed  later. 

Maternity  Hospitals 

There  are  two  maternity  hospitals  in  Greater  Berlin  that 
demonstrate  clearly  the  nature  of  the  work  of  the  public  hos- 
pital for  cases  of  pregnancy  and  confinement.  One  is  the  City 
Maternity  Hospital.  This  Maternity  Hospital  at  Charlotten- 
berg  is  the  only  maternity  hospital  in  Berlin  supported  and  run 
by  the  City.  It  is  a  decidedly  well  equipped  institution,  housed 
in  a  large  grey  cement  building,  three  stories  high,  constructed 
aJbout  an  open  garden  or  court.  The  interior  is  colored  in  white 
and  tan — plaster  walls,  and  tiled  floors.  The  equipment  is  quite 
modern  in  all  details,  as  the  place  was  finished  only  in  1913. 
The  organization,  however,  is  not  new,  and  its  maternity  division 
existed  formerly  in  a  less  fine  home  in  another  part  of  the  city. 

Seven  resident  doctors  and  forty  trained  nurses  are  in  care 
of  the  200  women  patients  and  perhaps  100  infants.  The  cases 
are  cases  for  confinement  or  for  gynecological  treatment.  There 
is  a  special  operating  room  for  gynecological  cases  as  well  as 
two  rooms  for  delivery  cases.  (It  may  be  noted  here  that  both 
in  Sweden  and  Germany,  deliveries  are  executed  on  the  bed,  not 
on  operating  tables,  as  is  the  case  in  the  more  modern  American 
hospitals). 

The  patients  are  required  to  pay  12  marks  a  day.  If  the 
individual  is  too  poor  to  afford  this  amount  the  Public  Sick 
Fund,  or  the  Social  Welfare  Deputation  meets  the  fee*  No  cer- 
tificate or  recommendation  from  any  authority  is  necessary  for 
admission  to  the  hospital.  Both  married  and  unmarried  women 
are  taken  and  the  rooms  are  arranged  to  accommodate  from  two 
to  ten  persons.  The  infants  are  not  kept  in  separate  nurseries, 
as  is  done  in  the  Kaiserin  Auguste  Victoria  Haus.  One  finds 
in  Sweden  too  that  the  infants  and  mothers  remain  in  the  same 
ward  or  room  together. 


The  Social  Welfare  Deputation  is  the  converted  Poor  Law  Board. 

14 


Public  Maternity  and  Infant  Care 

After  the  mothers  leave  the  hospital  they  may  proceed,  if 
destitute,  to  the  various  private  homes  for  women  and  their 
babies,  or  to  the  Westend  Home  for  Children  and  Mothers,  which 
belongs  to  the  City. 

Unlike  the  City  or  State  Maternity  Hospitals  in  Stockholm, 
the  Berlin  Maternity  Hospital  provides  for  pre-natal  care.  A 
clinic  is  held  twice  a  week,  to  which  pregnant  women  may  come 
for  examination,  advice,  and  minor  treatments. 

(It  was  not  possible  to  secure  the  cost  of  the  hospital  to  the 
city). 

The  amount  of  work  that  this  hospital  does  is  clear  from  the 
following  statistics  taken  from  the  hospital  books.  In  1919, 
1440  women  were  admitted.  The  living  born  numbered  1043, 
the  dead  born  44.  Deaths  of  infants  after  birth  were  50. 
There  were  66  gynecological  cases  in  1919  and  413  abortions. 

The  most  famous  maternity  hospital  in  Germany  is  the 
Kaiserin  Auguste  Victoria  Haus,  also  at  Charlottenberg.  This 
Hospital,  Home,  and  Training  School  for  the  care  of  mothers 
and  infants  exists  for  the  purpose  of  providing  the  most  scien- 
tific treatment  for  four  types  of  cases.  It  treats  diseases  of 
pregnancy,  normal  confinement  cases,  healthy  children  whose 
mothers  are  at  work,  and  ill  children.  In  addition  it  serves  as 
a  training  school  for  100  women,  who,  after  a  year's  course  in 
the  hospital,  try  a  State  examination,  and  if  successful  may  hire 
themselves  out  as  professional  infant  nurses. 

The  Hospital  divides  its  patients  into  1st,  2nd,  and  31x1 
classes,  according  to  the  bed  occupied  by  the  patient.  Unmar- 
ried women  about  to  become  mothers,  may  enter  the  Hospital 
three  or  four  months  previous  to  confinement,  working  in  the 
meantime  to  pay  for  their  board.  After  childbirth  such  cases 
may  remain  so  long  as  a  year,  provided  they  perform  adequate 
work. 

The  Hospital  is  in  the  medical  charge  of  five  resident  and 
ten  visiting  doctors,  two  midwives,  and  forty  trained  nurses. 
No  operations  are  performed  in  the  Hospital,  and  complicated 
confinement  cases  are  not  taken.  A  pre-natal  clinic,  supported 
by  the  City,  is  maintained  in  connection  with  the  Kaiserin  Au- 
guste Victoria  Haus,  open  twice  each  week,  where  women  may 
go  for  examination  and  advice. 

The  physical  environment  of  the  place  is  beautiful.     The 

15 


Public  Maternity  and  Infant  Care 

large,  finely  designed  building  of  gray  cement  is  set  in  attrac- 
tive grounds,  and  all  details  are  maintained  with  taste. 

The  Foundation  which  supported  this  center  of  science  for 
maternity  and  infant  care  is  private,  and  until  1914,  received  no 
aid  from  the  public.  ISince  that  date,  however,  the  Republic 
pays  250,000  marks  a  year;  a  small  sum,  when  one  considers 
that  the  annual  cost  for  maintenance  is  3  1-2  million  marks  a 
year. 

The  Kaiserin  Auguste  Victoria  Haus  performs  an  import- 
ant function  in  Germany,  as  a  leader  in  propaganda  work  for 
general  education  in  hygienic  maternity  and  infant  care. 
Pamphlets  and  leaflets  are  issued  on  these  subjects  and  it  is 
seen  that  such  information  reaches  the  hands  of  those  who 
should  have  it,  by  the  use  of  the  Birth  Registration  offices,  as 
distributing  agents.  A  magazine  for  doctors  and  nurses  is  is- 
sued monthly,  called,  "Sauglinge-und-Kleinkinderschutz," 
which  treats  the  problem  from  a  scientific  standpoint. 

The  statistics  published  by  the  Hospital  which  are  of  inter- 
est follow.  The  report  is  dated  from  April,  1918  to  31st  March, 
1919. 

A— 

1.     Women.  (Not  including  confinement  cases) 

Married  Unmarried 

At  the  beginning  of  the  [Report  Year 6  28 

New    cases    216  100 


222  128 

Total  350 
2.     Confinement  Division. 

At  the  beginning  of  the  Report  Year 7  11 

New    cases    201  70 


208  81 

Total    289 
B— 

Children.  Legitimate  Illegitimate 

At  the  beginning  of  the  Report  Year 65  72 

New    cases    803  193 


868  265 

Total  1133 


16 


Public  Maternity  and  Infant  Care 

(Deaths  for  women  are  not  given  in  the  Hospital  Report. 
Of  the  sick  children  numbering  768  of  the  total  1133,  148  died.) 

In  Stockholm  public  hospital  care  for  maternity  cases  is 
covered  by  the  two  large  institutions  operated  by  the  State  and 
Municipal  Health  Departments  respectively.  They  correspond 
in  general  characteristics  to  the  City  Maternity  Hospital  in  Ber- 
lin. Their  main  differences  lie  in  the  fact  that  they  do  not  pay 
as  much  attention  to  the  pre-natal  clinic.  The  General  Mater- 
nity Hospital,  existing  under  the  State  Health  Department,  may 
be  used  by  women  from  any  part  of  Sweden  and  is  supported  by 
the  State.  The  income  from  a  capital  fund  which  has  been  ac- 
cumulated gradually  through  gifts  makes  up  part  of  the  total 
budget.  The  hospital  was  founded  in  1775,  and  the  new  build- 
ing which  is  located  on  high  ground  not  far  from  the  Stadium, 
on  Planterhagsvagen,  was  erected  in  1913.  This  new  hospital 
is  a  large  white  cement  building  of  rectangular  proportions,  con- 
structed about  an  open  courtyard,  thus  affording  light  to  all 
rooms  and  corridors.  It  accommodates  about  100  patients  who 
in  the  main  are  drawn  from  the  poorer  groups  in  Stockholm, 
whose  treatment  in  the  hospital  is  free,  and  whose  only  requisite 
for  admission  is  a  birth  certificate  from  their  respective  parish 
registrars.  For  the  care  of  the  women  there  are  seven  graduate 
nurses  and  four  doctors.  Besides  these  superior  persons  are  ten 
nurses  in  training  and  twenty-five  medical  students  who  live  on 
the  upper  floor  of  the  hospital,  and  work  in  the  hospital  for  four 
months  between  the  third  and  fourth  years  of  their  medical 
course,  as  a  part  of  their  obstretical  and  gynecological  training. 

The  interior  arrangements  and  equipment  of  this  modern 
maternity  hospital  are  excellent  in  all  details.  Unlike  the  Ber- 
lin City  Hospital  each  maternity  patient  has  a  separate  delivery 
room.  After  the  delivery  the  mother  and  infant  are  removed 
to  the  convalescent  ward,  which  holds  from  one  to  six  patients. 
The  operating  rooms  are  large,  light,  and  perfect  in  their  access- 
ories. One  ward  of  the  hospital  is  given  over  to  gynecological 
cases.  Among  the  hospital's  patients  are  many  cases  of  crimi- 
nal abortion  which  are  frequent  in  Stockholm.  The  number  of 
abortion  cases  in  the  hospital  in  1919  were  630  with  eight  deaths, 

17 


Public  Maternity  and  Infant  Care 

Statistics  for  the  hospital  for  1919,  as  given  in  the  year  book  of 
Stockholm's  Municipal  Board  of  Health,  are  as  follows: — 

Total  entered  2638 

For    delivery    2429 

Under  20  years  126 

Under  2030  years 1449 

Under  30-40  years 7'33 

Over  40  years 121 

Other  cases  209 


Children  bom — 

Living  at  full    term  1710 

Living  before    term    62 

Dead  born  full  term 35 

Dead  born  before  term 15 

Miscarriages     630 


Total  Cases — 

Deliveries   without  .abortions 1799 

Abortions 630 

Other  cases  209 


2638 
In  1919  the  hospital  reports: 

Total  expenditures    339,061.04  Cr. 

■   Paid  by  State    316,694.       Cr. 

The  hospital  makes  no  specialty  of  pre-natal  work.  Women 
may  go  there  for  advice  and  examination  during  pregnancy,  but 
no  emiphasis  is  laid  on  this  phase  of  care. 

Adjoining  the  hospital  is  a  private  home  for  the  care  of 
mothers  and  babies  who,  after  their  eight  or  nine  days  in  the 
hospital,  have  no  place  to  go.  There  are  places  for  fifty  such 
mothers  and  they  may  remain  in  this  shelter  for  six  weeks,  after 
which  time  they  must  seek  other  accommodations.  In  general 
such  women  find  a  position  for  work  at  the  end  of  the  six  weeks, 
while  the  infant,  usually  illegitimate,  is  boarded  out  by  the  Poor 
Law  Authorities. 

18 


Public  Maternity  and  Infant  Care 

The  work  done  by  the  General  Maternity  Hospital  from 
the  social  standpoint,  needs  no  comment.  It  supplies  scientifi- 
cally and  effectively  a  constant  demand  in  the  city.  There  are 
but  two  criticisms  that  are  in  point — that  no  pre-natal  maternity 
clinic  is  maintained;  and  that  the  patients  are  kept  in  the  hos- 
pital too  short  a  time  after  childbirth.  As  the  Swedish  women 
are  exceedingly  strong,  these  two  defects  in  the  hospital  work 
apparently  do  not  have  far-reaching  effects. 

The  other  large  public  maternity  hospital  in  Stockholm 
under  the  City  Board  of  Health,  the  South  Maternity  Hospital, 
is  distinctly  a  city  institution.  It  derives  its  support  largely 
from  the  city  and  from  the  income  of  the  small  charge  on  pati- 
ents and  a  small  amount  of  capital  owned. 

The  hospital  is  ,a  spacious  yellow  cement  construction,  well 
adapted  to  its  needs,  though  it  is  not  as  modern  as  the  State 
Maternity  Hospital.  Each  woman  has  a  separate  delivery  room, 
being  moved  afterwards  to  the  general  wards.  The  patients  re- 
main in  the  hospital  ten  days.  The  charge  for  Stockholm 
women  ranges  between  3  and  12  crowns  a  day,  according  to 
the  desirability  of  the  bed.  Most  of  the  women  are  from  the 
City  of  Stockholm,  but  they  are  permitted  to  enter  from  other 
parishes,  in  which  cases  the  rate  ranges  between  7  and  8  crowns 
a  day. 

In  charge  of  the  hospital  work  is  one  supervising  doctor 
and  his  assistant,  beside  four  midwives.  In  addition  there  are 
sixty  women  in  training  for  midwifery  who  remain  in  the  hos- 
pital one  year,  after  which  time,  provided  they  pass  the  state 
examination  and  are  licensed  under  the  State  Board  of  Health, 
they  are  sent  out  by  said  State  Board  to  various  communes  in 
Sweden.  A  trained  midwife  is  appointed  for  each  district.^  The 
district,  a  classification  made  and  used  by  the  State  Department 
of  Health  on  the  basis  of  population,  is  a  division  of  a  county 
and  represents  about  3000  persons.  The  state  pays  each  mid- 
wife the  small  annual  sum  of  800  crowns.  From  her  patients 
she  receives  from  15  to  25  crowns  for  each  delivery — an  ex- 
tremely small  amount  for  the  responsibility  involved.  In  the 
cities  a  midwife  may  charge  as  high  as  150  crowns,  and  in 
Stockholm  the  City  Health  Board  pays  in  addition  to  the  state 
wage  10  croviTQS  for  each  confinement  case.  In  cases  that  are  not 
normal  the  midwife  is  required  by  law  to  call  in  a  doctor.  In 
order  that  the  elder  group  of  midwives  may  not  suffer  by  the 
progress  in  obstretical  science,  repetition  courses  for  their  bene- 

19 


Public  I\Iaternity  and  Infant  Care 

fit  are  held  every  ten  years  at  Goteborg  and  Stockholm,  for  a 
period  of  fourteen  days.  Since  in  the  country  almost  all  of  the 
women  are  delivered  by  midwives,  and  there  is  only  one  other 
such  training  school,  namely  ^t  Goteborg,  the  work  done  by  this 
hospital  is,  in  this  respect,  particularly,  of  importance. 

(Statistics  of  interest  as  given  by  Stockholm's  Municipal 
Board  of  Health  for  1919  show  :— 


Children  born — 

Living  bom   full  term 2182 

Living  born  before  term  150 

Dead  born  full  term 33 

Miscarriages     528 


Total  cases — 

Deliveries  without  abortions 2350 

Abortions 528 

Other  cases  343 


3221 


Total  cost    441,860.18  Cr. 

Cost  to   City 327,061.      Cr. 


20 


Public  Maternity  and  Infant  Care 

o  o 


Cost  to  Public 

CJ  to 
«D     O 

CO     CQ 

Tj<  00 
O       rH 

Total  Cost 

tA       O 

CD  iO 
O     00 

of     tH 

CO    Tif 

CO     ^ 

%  to  Deliveries       °9  ^S 


still  Born 


Total  Deaths 


O     <M 


%  to  Deliveries        '=^.  ^ 

CO  ^ 

1^  Premature  Births    S  ^ 

^  %  to  Deliveries        g  g 

O 

Live  Births 


t-    CO 

t-     CO 


s 

g  %  to  Total  ^  2 

§  Cases  =^  ^ 


O     00 


^  Abortions  «§  S 

g  %  to  Total  ^  S- 

g  Cases  «o  t~ 

S  Oi  o 

o  Deliveries  ?^  co 

O  "^  ^ 

w  %  of  Deaths  53  g 

to  Total  o  o 


Total  Cases 

CO   cq 

«0     CO 

(M     CO 
1         1 

ii 

Hosp. 

02  u 

21 


PART  II —INFANT  CARE 

The  institutions  in  Berlin  and  Stockholm  pertaining  more 
definitely  to  the  care  of  babies,  while  of  necessity  a  part  of  the 
care  for  maternity,  may  be  dealt  with  as  organizations  designed 
for  the  protection  of  infants  and  young  children,  since  the  em- 
phasis is  placed  on  that  aspect  of  the  dual  problem.  As  in  re- 
gard to  maternity  mortality,  the  statistics  for  Sweden  and  Ger- 
many for  infant  mortality  exhibit  results  that  might  indicate 
the  superiority  of  the  social  machinery  th^at  operates  for  the 
care  of  infants.  Hence  it  may  not  be  useless  to  survey  briefly 
the  typical  organizations  in  Berlin  and  Stockholm  confined  to 
this  phase  of  the  work. 

Infant  mortality  rates  for  certain  foreign  countries  and  United  States 
per  1,000  live  birtihs 


Chile  (1919) 

306 

Hungary  (1915) 

264 

Bavaria  (1918) 

203 

Japan  (1918) 

189 

Spain  (1918) 

183 

Italy  (1916) 

166 

Germany  (1920) 

135 

Prussia  (1919) 

121 

France  (77  Depts.,  1919) 

119 

Finland  (1918) 

115 

Scotland  (1919) 

102 

Uruguay  (1919) 

101 

Ontario  (1919) 

96 

Denmark  (1919) 

92 

Ireland  (1919) 

88 

U.  S.  (Birth  Registration  Area,  1920) 

86 

Netherlands  (1919) 

84 

Switzerland  (1919) 

82 

England  and  Wales  (1920) 

80 

Sweden  (1916) 

70 

Australia  (1920) 

69 

Norway  (1917) 

64 

New  Zealand  (1920) 

51 

Source:  Comipiled  from  official  sources  or  from  Annuaire 
International  de  Statistique  by  the  Federal  Children's  Bureau. 
Latest  figures  available,  January  1,  1922. 

22 


Public  Maternity  and  Infant  Care 

Departments  of  Public  Guardianship 

As  mentioned  before,  the  prominent  administrative  organ 
dealing  with  children,  and  existing  in  both  Berlin  and  Stock- 
holm, is  that  for  the  protection  of  the  illegitimate  child.  In 
Berlin  it  is  the  second  section  of  the  Division  of  Public  Guard- 
ianship, and  in  Stockholm,  the  Board  for  Child  Welfare.  A 
short  description  of  each  organization  will  reveal  the  points  of 
similarity  and  dissimilarity. 

In  Berlin,  when  an  illegitimate  infant  is  born  the  local  City 
Registrars  are  required  to  report  the  birth  to  the  Division  of 
Public  Guardianship,  which  thereupon,  immediately  appoints  a 
Public  Guardian  for  the  child.  This  guardian  supervises  the 
development  of  the  child  until  it  is  twenty-one  years  of  age. 
There  are  twenty-four  Public  Guardians  in  Berlin,  each  of 
whom  has  in  his  or  her  care  about  one  thousand  children.  It  is 
furthermore,  the  duty  of  the  Public  Guardian  to  see  that  the 
father  makes  the  payment  to  the  mother  of  the  child,  that  is  re- 
quired by  law.  In  1920  eight  million  marks  were  taken  in  by 
the  Division  of  Public  Guardianship  and  paid  over  to  unmar- 
ried mothers.  This  amount  of  money  was  paid  by  the  unmar- 
ried fathers  according  to  legal  regulation. 

If,  after  the  period  of  confinement,  the  mother  and  infant 
are  destitute,  there  are  several  homes  partially  supported  by  the 
City,  to  which  the  pair  may  be  sent  to  remain  for  varying  per- 
iods of  time.  There  is  one  notable  municipal  home  for  Chil- 
dren and  mothers,  The  West  End  Municipal  Home  for  Moth- 
ers and  Children  at  Charlottenberg,  which  costs  the  city  a  con- 
siderable sum  to  run,  since  it  has  place  for  ninety  mothers  and 
one  hundred  and  sixty  children,  with  one  resident  doctor,  twen- 
ty-eight trained  nurses,  and  eight  teachers. 

If  the  mother  is  to  be  separated  from  her  baby,  through 
force  of  circumstance,  the  infant  is  sent  to  the  Municipal  Or- 
phan Home  or  to  a  partially  private  home  until  a  place  in  a 
family  is  found  for  the  child.  In  1920  the  Division  of  Public 
Guardianship  in  Berlin  handled  19,176  eases.  (It  was  not  pos- 
sible to  secure  figures  of  cost  to  the  city) . 

In  Sweden  the  administrative  agent  for  the  purpose  of 
guarding  the  illegitimate  child  is  the  local  Board  for  Child  Wel- 
fare, an  authority  which  was  created  by  law  in  1902,  and  came 
mto  existence  in  1903.     A  Board  for  Child  Welfare  exists  in 

23 


Public  Maternity  and  Infant  Care 

each  parish  in  Sweden.  These  Boards  are  under  the  super- 
vision of  the  State  Social  Department.  The  province  of  the 
Board  for  Child  Welfare  is  to  supervise  and  care  for  (1)  mor- 
ally defective  children  and  (2)  children  born  out  of  wedlock. 
The  second  division  has  been  in  operation  in  Stockholm  since 
1918. 

In  Stockholm  the  division  of  the  Board  for  Child  Welfare, 
which  deals  with  illegitimacy,  has  its  headquarters  in  an  office 
at  Hamngatan  36.  About  one  third  of  the  budget  is  carried  by 
the  state  and  two  thirds  by  the  city.  This  central  office  deals 
with  illegitimate  ehildren  for  the  entire  city.  The  important 
members  of  the  staff  are  a  head  inspector,  who  acts  as  super- 
visor, thirty  salaried  and  eighty-five  volunteer  Public  Guard- 
ians, or  persons  who  are  directly  in  charge  of  the  individual 
children.  The  birth  of  an  illegitimate  child  is  reported  to  the 
central  Board  by  the  pastor,  who  is  official  birth  registrar  of 
the  parish  in  which  the  child  is  born.  If  the  child  has  been 
born  in  a  hospital,  both  the  hospital  authority  and  the  parish 
pastor  must  send  word  of  the  birth.  Midwives  and  doctors  are 
legally  liable  to  notify  the  pastor  when  they  have  delivered  an 
unmarried  mother.  As  soon  as  a  case  is  reported  a  Public 
Guardian  is  sent  to  take  the  situation  in  charge  permanently. 

The  first  duty  of  the  Public  Guardian  is  to  have  the  father 
of  the  child  identified.  The  mother's  word,  regardless  of  the 
type  of  person  she  may  be,  or  what  her  reputation  is,  is  accepted 
at  first  as  a  guide  to  action.  If  the  man  denies  parentage,  the 
matter  is  brought  to  court  under  the  law.  If  the  father  ac- 
knowledges paternity  a  standardized  printed  form  is  filled  in 
and  signed  by  him  in  the  presence  of  the  Public  Guardian  as 
acknowledgment  that  he  is  the  father,  and  as  a  pledge  to  sup- 
port the  child  according  to  the  provisions  of  the  law.  One  man 
is  held  responsible  for  fatherhood  even  though  there  have  been 
several  men  involved.  If  the  man  selected  by  the  mother  as  the 
father  of  her  child  is  in  another  city  or  country,  he  is  subject, 
nevertheless,  to  the  law  and  may  be  traced  by  police  or  consuls. 
If  he  is  in  an  occupation  that  carries  him  out  of  Stockholm,  and 
one  the  wage  of  which  is  paid  from  Stockholm,  the  amount  for 
the  support  of  the  child  may  be  subtracted  from  the  wage  be- 
fore payment. 

The  duty  of  the  Public  Guardian,  once  the  father  has  been 
apprehended,  is  to  watch  the  education  of  the  child  and  to  fol- 
low up  the  payments  of  the  father.     The  Public    Guardian   is 

24 


Public  Maternity  and  Infant  Care 

supported  in  all  his  duties  by  legral  right.     That  the  system  as 
outlined  has  been  fruitful  in  results  is  evidenced  by  the  follow- 
ing statistics. 
Number  of  cases  supervised  1919. 

Carried  over  from  previous  year 1507 

New  cases  during  the  year 1697 

Total  cases  handled  in  1919 3204 

Cases  closed  during  the  year : 

Because  of  the  marriage  of  parents.  . .  .     163 

By  the  death  of  the  child 199 

Transfer  of  child  to   another   source   of 

protection      112 

For   other   causes    17  491 

2713 
Number  of  cases  in  which  paternity  was 

established  2076 

Number  of    cases    regarding    paternity 

which  were  dropped  as  incapable  of 

being  settled  237 

Number  of  cases  in  which  paternity  was 

not  settled  at  the  end  of  the  year       400  2713 

(Derived  from  the  Statistical  Yearbook  of  the  City  of  Stock- 
holm, 1920) 

A  certain  decentralization  of  delegated  authority  in  the  care 
of  the  illegitimate  child  exists  in  Stockholm  through  the  over- 
lapping provinces  of  the  Poor  Law  and  Municipal  Health  au- 
thorities. When  a  child  is  boarded  out  in  Stockholm  it  comes 
under  the  supervision  of  the  Bureau  for  the  Inspection  of  Foster 
Children,  of  the  Municipal  Health  Department,  as  well  as  under 
the  supervision  of  the  Public  Guardian,  unless  it  be  boarded  out 
by  the  Poor  Law  Board,  whereupon  it  is  in  charge  of  the  Poor 
Law  Board  as  well  as  the  Public  Guardian. 

Destitute  cases  are  maintained  usually  in  the  Poor  Law  or 
semi-private  institutions  at  a  nominal,  or,  if  necessary,  no 
charge,  for  a  limited  period  until  permanent  arrangements  can 
be  made.  Usually  the  period  of  respite  for  the  destitute  mother, 
during  which  time  she  is  restored  to  health  and  efficiency,  lasts 

25 


Public  Maternity  and  Infant  Care 

for  about  a  year  after  the  birth  of  the  child.  At  the  end  of  this 
time  either  a  position  is  found  for  the  mother  where  she  may 
keep  her  baby  with  her,  or  the  child  is  boarded  out  in  a  care- 
fully selected  family  and  the  mother  finds  work  alone.  In  gen- 
eral it  seems  to  be  true  that  the  great  majority  of  illegitimate 
children  are  boarded  out  and  the  mother  goes  to  work.  The 
Board  for  Child  Welfare  maintains  five  institutional  homes  for 
children  where  they  may  receive  temporary  shelter  for  varying 
periods  of  time.     (See  note  *  and  **). 

In  Berlin  the  decentralization  apparent  in  Stockholm  does 
not  exist.  The  Division  for  Public  Guardianship  is  a  part  of 
the  central  Department  for  the  Welfare  of  Children  and  is  re- 
sponsible alone  to  that  authority.  The  inspection  of  foster  chil- 
dren is  carried  on  by  a  division  also  of  the  Department  for  the 
Welfare  of  Children,  whereas  in  Stockholm,  the  Municipal 
Health  Board  asserts  control. 

Municipal  Clearing  House  for  Foster  Children 

The  Municipal  Orphan  Home  at  33  Altejacobsstrasse,  in 
Berlin,  is  typical  of  work  done  both  in  Berlin  and  Stockholm, 
as  a  clearing  house  for  children  who  are  to  be  placed  out. 

This  Orphanage,  supported  entirely  by  the  Municipality, 
and  supervised  by  the  Department  for  the  Welfare  of  Children, 
is  a  home  and  clearing  house  for  about  fifteen  thousand  chil- 
dren, who  are,  or  are  to  become,  temporarily  or  permanently, 
foster  children.  These  children  are  by  no  means  all  orphans  in 
the  strict  sense  of  the  term,  but  are  situated  so  that  it  is  necess- 
ary for  them  to  be  boarded  out  with  a  family,  or  to  be  cared  for 
in  the  Orphan  Home.  The  children  come  to  the  Home  through 
the  Department  for  Social  Welfare,  or  from  the  Division  of 
Public  Guardianship,  and  remain  in  the  Home  not  longer  than 


*  Guinchard — Sweden,  Land  and  People,  Vol.  1,  p.  163-  In  the 
years  1901-10,  33.6%  of  the  children  born  alive  in  Stockholm  were 
born  out  of  wedlock. 

**  Statistical  Yearbook  for  City  of  Stockholm,  1920  Table  29, 
Births  in  Stockholm. 


Year 

Living  Born 

Legitimate 

Illegitimate 

1902 

7426 

4993 

2433 

1907 

8153 

5342 

2811 

1912 

7436 

4717 

2719 

1917 

6634 

4618 

2016 

1919 

5887 

4287 

1600 

26 


Public  Maternity  and  Infant  Care 

the  two  or  three  months  they  are  waiting  to  be  boarded  out  with 
foster  parents,  who  will  be  paid  for  their  care. 

The  Orphan  Home  and  its  adjoining  house,  the  Asylum  for 
Children,  have  room  for  three  hundred  children,  of  whom  per- 
haps forty  are  ill  children,  receiving  medical  attention,  one 
hundred  and  seventy  are  infants  under  a  year  old,  and  the  re- 
mainder are  healthy  older  children  awaiting  their  new  homes. 
No  infants  are  turned  over  to  foster  parents  from  the  Orphan 
Home  before  reaching  three  months  of  age.  In  immediate 
charge  of  this  group  of  children  are  six  doctors,  four  graduate 
nurses,  and  sixty-one  women  helpers  for  the  Orphan  Home; 
for  the  Aslyum  for  Children  are  the  same  doctors  and  forty 
women  helpers. 

The  building  of  the  institution  was  erected  in  1907.  (The 
organization  dates  back  to  1850).  The  house  is  of  gray 
cement,  five  stories  high,  and  constructed  about  a  court  yard, 
The  interior  walls  are  painted  dark  green,  and  in  comparison 
to  the  bright  Swedish  coloring  of  similar  places,  the  atmosphere 
within  the  home  is  somlbre.  The  general  condition  of  plaster, 
woodwork,  floors,  etc.,  is  poor,  due,  of  course,  to  the  scarcity  of 
money  since  the  war.  The  enforced  economies  have  affected 
more  important  items  than  physical  environment,  however,  as 
one  saw  by  a  glance  at  the  meal  of  yellow  potato  soup  that  the 
children  were  eating  for  dinner. 

The  Orphan  Home  maintains  a  clothes  room,  where  out- 
fits of  new  clothing  for  children  of  all  sizes  from  infancy  to 
fourteen  years  are  stored.  The  clothing  is  purchased  by  the 
Orphanage, — a  contrast  to  a  similar  institution  in  Stockholm, 
where  clothing  is  made  in  the  sewing  room,  and  affords  work 
to  poor  women  who  are  known  to  the  Poor  Law  authorities. 
The  clothes  were  of  as  good  quality  as  could  be  expected,  under 
the  severe  economic  conditions  in  Germany. 

The  Orphan  Home  maintains  three  teachers  for  boys  and 
two  for  girls,  so  that  all  waiting  children  of  school  age  have 
their  proper  lessons  in  well  fitted  school  rooms. 

The  Asylum  for  Children,  already  mentioned  as  under  the 
same  supervision  as  the  Orphanage,  and  for  all  practical  pur- 
poses existing  as  a  part  of  that  institution,  is  an  institution 
which  in  addition  to  municipal  support,  receives  an  income 
from  the  Schmidt-Gallisch  Foundation,  left  for  the  purpose. 
The  asylum,  housing  infants  only,  with  beds  for  one  hundred 
and  twenty,  is  of  the  finest  modem  equipment  and  construction, 

27 


Public  IMaternity  and  Infant  Care 

built  in  1915,  attractively  decorated  and  in  rather  marked  con- 
trast to  the  Orphan  House.  The  infants  are  separated  in 
groups  of  two  or  three  by  glass  compartments,  so  that  less  dan- 
ger of  infection  exists.  The  children  are  in  charge  of  the  same 
doctors  as  work  in  the  adjoining  Home  and  are  destined  to  be 
foster  children. 

The  general  statistics  for  the  two  above  institutions,  dated 
April  1st,  1917,  and  covering  the  preceding  year,  published  by 
the  Municipal  Council  of  Berlin,  are  given  below. 

General  Statistics 

From  April  1,  1916  to  April  1,  1917 

iContrasted  to  April  1,  1916 
iMale    Female  Together    +  more 

(a)  Parentless   5368  4481  9849  —  452 

(lb)  Taken  out  of  evil  surroundings— 3226  1820  5046  +  819 

(c)  Children  of  the    unemployed 12  10  22  -t-     10 

(d)  Children  of  the  S.  G.  Found- 29  29  58  —    23 

Total 8635         6340       14975 

On  April  1,  1916 8263         6368       14621         +  354 

It  will  be  observed  by  the  Table  that  three  hundred 
and  fifty-four  children  were  added  in  1917  to  the  total 
already  in  the  care  of  the  Orphanage  and  the  Department  for 
the  Welfare  of  Children.  That  is,  in  the  year  ending  April 
1st,  1917,  14,975  children  were  destitute  children  of  the  Depart- 
ment of  Child  Welfare  of  the  City  of  Berlin  or  were  children 
cared  for  in  the  Orphanage  by  foster  parents. 

Clinics  and  Milk  Stations 

The  Stations  for  the  Care  of  Babies  in  Greater  Berlin  are 
institutions  unlike  any  in  Stockholm.  There  are  ten  in  the  city 
and  each  serves  the  purpose  of  hospital  clinic,  milk  station  and 
family  physician. 

The  particular  station  under  discussion  is  located  at  10 
Badstrasse.  It  is  a  new  building,  having  been  finished  during 
the  war,  of  gray  cement,  three  stories  high,  and  of  comfortable 
size.  It  is  maintained  by  the  City  under  the  direction  of  the 
Department  for  the  Welfare  of  Children.  On  the  ground  floor 
are  the  doctors'  private  offices,  the  large  entry  hall,  and  the  sep- 
arate entry  and  room  for  contagious  cases.     This  latter  room  is 

28 


Public  Maternity  and  Infant  Care 

divided  by  glass  partitions  for  protection  against  infection.  On 
the  second  floor  are  dressing  room,  weighing  room,  two  examin- 
ing rooms,  operation  room,  and  business  office.  On  the  third 
floor  are  the  bedrooms  of  the  nurses  and  the  milk  kitchen  which 
is  equipped  with  the  most  modern  contrivances. 

Three  doctors  spend  two  hours  each  a  day  at  the  Station, 
and  seven  nurses  and  helpers  do  the  general  work.  These  indi- 
viduals examine  during  a  year  as  many  as  2500  infants,  and 
1500  children  between  one  and  six  years. 

The  function  of  the  Infant  Station  is  to  examine,  advise, 
and  treat  children  between  birth  and  six  years  of  age,  who  are 
too  poor  to  obtain  other  medical  help.  Mothers  may  come  here 
with  their  children  without  recommendation  or  certificate  from 
a  public  authority,  and  all  treatment  is  free.  For  the  milk  that 
is  dispensed  the  recipients  pay  a  low  price. 

One  of  the  important  functions  of  the  work  is  to  act  as  a 
propaganda  center  for  the  encouragement  of  breast  feeding. 
The  Stations  are  the  centers  from  which  the  nursing  premiums 
granted  by  the  State  are  distributed.  This  money  is  paid  every 
three  months. 

The  system  of  Stations  for  Infant  Care  is  not  new  in  Ber- 
lin, dating  back  at  least  fifty  years. 

Statistics  of  the  cost  of  the  nine  stations  existing  in  1915 
as  given  by  the  Statistics  of  the  Council  of  Berlin  are : 

Nursing  War 

Stations  Premium  Milk  Officials  Tax  Rent  Uiakeep  Total 

1  17,189     17,680  12,999  908  6,600  5,296  59,672 

2  13,010       9,046  12,165  881  1,792  5,873  42,767 

3  13,709     12,241  12  828  917  980  3,255  43,930 

4  15,241     24,134  10',869  768  3,200  3,355  57,567 

5  10,887     25A31  11,782  896  5,000  4,919  58,615 

6  12,259     13,940  11,783  768  2,100  3,999  44,849 

7  17,859     23,218  11959  840  1,815  4,022  69,713 

8  16,135     20,883  13",252  1,058  2,628  4,081  58,037 

9  11,251     19^671  11746  1,004  2,310  3,181  49,163 


Marks        127,540  166,944  109,383     8,040  25,425  37,981  474,313 

Stockholm  has  an  Association  of  Milk  Stations,  which,  as  a 
partly  public  organization,  supplies  the  demand  for  which  milk 
depots  exist.  There  are  six  milk  stations  for  infants,  Katar- 
ina's  Milk  Depot,  Skanagatan  72,  Adolf  Fredrik's,  Vidargatan4, 
Kungsholmen's,  Drottningholmsvagen  12-A,  Ostermalm's,  Frej- 

29 


Public  Maternity  and  Infant  Care 

gatan  3,  Jakob's  and  Johannes',  Dobelnsgatan  38-B  and  Brann- 
kyrka's,  Skoldgatan  3.  These  milk  depots  are  for  the  purpose  of 
overseeing  the  first  year's  development  of  babies,  of  providing 
proper  milk  and  milk  formulas  for  them,  and  of  giving  the 
mothers  general  valuable  advice.  The  cost  of  the  stations  is 
borne  in  part  by  the  city,  through  the  Poor  Law  Board  and  the 
Health  Department.  It  may  be  of  interest  in  this  connection 
to  present  the  income  figures  for  1919  of  one  representative  sta- 
tion : — 

Jakob's  and  Johannes'  Milk  Depot  Income  for  1919: 

From  the  Poor  Law  Board Cr.       3,417 

From  Johannes'  Parish 1,200 

From  Jakob's  Parish 1,200 

From  the  Association  of  Milk  Stations. .  4,500 

Gifts    120 

Annual    Fees     507 

Interest    297.59 

Payment  for  milk    1,134.39 

Payment  for    bottles   65.60 

Rents    120 

Board  of  Health  3,549.25 

Total     16,109.83 

The  central  association  which  contributes  Item  four  in  the 
account  just  given  is  a  private  organization  composed  of  mem- 
bers who  through  a  board  consisting  of  representatives  from 
each  of  the  stations,  plus  a  doctor  who  is  president,  act  as  mana- 
gers and  organizers  of  the  stations. 

Statistics  for  the  year  1919  as  given  in  the  brief  annual 
pamphlet  issued  by  the  association  are : — 

Per  cent. 
Stations  ^^f^l  Deaths      of  Deaths 

Infants  to  Total 

Katarina's    180  4  1.7 

Adolf    Fredrik's     102  0  .0 

Kungsholmen  's    183  1  ,  .5 

Ostermalm's     118  1  .9 

Jakob's   and   Johannes'    ..95  2  2.1 

Brannkyrka's 258  3  1.2 

Total 936  10  1.1 

SO 


Public  Maternity  and  Infant  Care 

The  stations  are  used  by  the  wives  of  working  men  and 
usually  these  women  can  afford  to  pay  1  crown  for  a  visit,  which 
includes  milk.  Of  the  sixty-three  women  who  were  attending  the 
Ostermalns  Milk  Station  in  November,  1920,  but  four  were  un- 
able to  pay.  If  the  infants  are  breast  fed  no  charge  is  made 
for  care  given  at  the  station.  To  encourage  mothers  to  give 
their  babies  breast  milk  only,  the  city,  through  the  milk  stations, 
pays  45  crowns  a  month  to  women  who  nurse  their  infants.  One 
trained  nurse  and  an  assistant  presided  at  Ostermalms  Station, 
and  the  doctor  made  two  visits  a  week.  The  attending  doctor  is 
paid  1000  crowns  a  month  for  his  work  in  a  local  station. 

Children's  Hospitals 
In  Stockholm  the  Sach's  Baby  Hospital  is  a  typical  exam- 
ple of  a  first-class  public  children's  hospital.  It  is  supported  by 
the  City  Board  of  Health.  It  was  built  in  1911  at  Arstalunden, 
Stockholm,  beautifully  located  on  the  side  of  a  hill  overlooking 
the  Hammarbyleden  River,  and  Lake  Malaren.  The  hospital 
was  erected  with  private  money  and  then  presented  to  the  city 
of  Stockholm.  It  is  a  modem  building  of  modern  equipment. 
It  contains  fifty-four  beds  for  sick  children  under  two  years  of 
age,  in  charge  of  whom  are  two  doctors,  three  trained  nurses, 
twelve  women  in  training,  and  eight  wet  nurses.  There  is  also 
room  for  six  mothers  in  cases  in  which  infants  are  taking 
breast  milk.  Children  with  contagious  diseases  are  not  ad- 
mitted. 

Babies  are  brought  to  the  hospital  by  no  particular  author- 
ity. Poor  families  may  keep  their  infants  in  the  hospital  with- 
out charge,  provided  they  demonstrate  their  inability  to  pay  by 
presenting  a  parish  certificate  from  the  local  Poor  Law  Authori- 
ties to  this  effect.  Children  of  more  well-to-do  parents  pay 
3  crowns  a  day,  and  if  the  mother  remains  with  the  child 
1.50  crowns  a  day  in  addition.  Wet  nurses  remain  in  the  hos- 
pital one  year,  receiving  30  crowns  per  month,  and  board.  Af- 
ter children  leave  the  hospital  their  parents  are  encouraged  to 
bring  them  back  for  examination  and  advice,  in  order  that  ade- 
quate follow-up  work  may  be  done. 

In  1919  the  support  of  this  institution  was  divided  as  fol- 
lows : — 

From    patients   17,588        Cr. 

From  the  City   172,585.95  Cr. 

Interest  on  gifts   6,318.67  Cr. 

Other  receipts    539.33  Cr. 

197,031.95  Cr. 
31 


Public  Maternity  and  Infant  Care 

Further  statistics  from  the  1919  Report  of  the  Municipal 
Board  of  Health  are: 

PATIENTS 

Left  from  Preceding  Remaining  at 

Year                 Entered          Departed  Deaths      end   of  year 

42                        337                     289  49                  41 

Deaths  in  %  of        Days  in  Average    Days  Average  Number 

admissions  hospital  for  patients  of  patients 

14.54  17,700  52.5  54 

Kaiser  and  Kaiserin  Friedrich's  Children's  Hospital,  en- 
tirely supported  by  the  City,  is  the  foremost  children's  hospital 
in  Berlin.  The  hospital  was  founded  and  built  by  an  association 
of  citizens,  but  was  adopted  by  the  City,  at  least  a  decade  ago. 
The  cost  to  the  City  for  the  maintenance  of  the  place,  which  pro- 
vides four  hundred  fifty  beds  for  ill  children  up  to  fourteen 
years  of  age  for  all  general  and  contagious  diseases,  as  well  as  a 
bacteriological  division,  and  an  equipment  for  Roentgen  Rays, 
was  in  1920  about  5  1-2  million  marks. 

The  hospital  consists  of  a  group  of  red  brick  houses,  built 
on  a  small  campus.  The  system  provides  a  separate  pavilion 
for  each  disease  of  a  contagious  character,  and  a  pavilion  for 
general  illness. 

The  patients  are  cared  for  by  two  doctors  who  act  as  direc- 
tors, and  by  twenty-seven  internes,  of  whom  ten  live  on  the  prem- 
ises. The  nursing  is  done  by  one  hundred  trained  nurses  and 
there  are  seventy  domestics  for  general  work.  The  patients  come 
in  as  individuals,  not  necessarily  recommended  by  any  authority. 
The  patients  who  are  residents  of  Greater  Berlin  must  pay  6 
marks  a  day,  and  12  marks  a  day  if  they  are  not  residents  of 
the  City.     The  cost  to  the  City  per  patient  is  50  marks  a  day. 

In  1920  the  hospital  cared  for  3300  patients,  of  whom  770 
died.  The  Director,  Dr.  Finkelstein,  informed  the  writer  that 
there  existed  in  the  hospital  in  1920,  twice  as  many  cases  of  tub- 
erculosis as  before  the  war,  and  four  times  as  many  cases  of 
ricketts.  The  smaller  income  group  are  at  present  unable  to 
provide  nutritious  food  for  their  children  and  the  result  may  be 
seen  in  the  too  many  small  patients  suffering  from  malnutri- 
tion. 


32 


Public  Maternity  and  Infant  Care 
Year  53    S3 


O 


Cost  to  Public 


K 


33 


^ 


Total  Cost  W    S 


o 
o 
o 


s  ^ 


Deaths  in  %  of      ^    sv? 
Admisisons  ;2J    jo 


Deaths 
Admissions 


w     p 


a 

- 

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•  r-4 

S3 

a* 

O 

w 

a 

o 

>> 

^ 

OT 

^ 

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W 

fa 

Public  IVEaternity  and  Infant  Care 

The  following  table  is  derived  from  "Infant  Mortality  in 
Berlin  During  the  War  and  Later, ' '  by  Prof.  Dr.  H.  Silbergleit, 
Director  of  the  Statistical  Bureau  of  the  City  of  Berlin.  (Pub. 
1920). 

The  Development  of  Infantile  Mortality  in  Berlin 
From  1870^1919 

Deaths,  exclusive  of  Deaths  Children  Under 


Living  iBorn 

Dead  Born 

1  yr  in 

%  Living  Bom 

Year 

M. 

F. 

Total 

M. 

F. 

Total 

M. 

F. 

Total 

1870 

15629 

14749 

80378 

5648 

4526 

10074 

35.50 

30.69 

33.16 

1880 

22391 

21742 

44133 

7548 

6290 

13838 

33.71 

28.93 

31.36 

1890 

25362 

24084 

49446 

6951 

6672 

12623 

27.41 

23.55 

25.63 

1900 

25568 

24268 

49836 

6505 

5257 

11762 

25.44 

21.66 

23.60 

1910 

22704 

21487 

44191 

3862 

3074 

6936 

17.01 

14.31 

15.70 

1915 

16023 

14977 

31000 

2324 

1939 

4362 

15.12 

12.95 

14.07 

1919 

14596 

13233 

27829 

2081 

1682 

3663 

The  'German  institutions  described  above  cover  in  the  main, 
types  of  Municipal  work  and  of  work  aided  by  the  Municipality 
for  needy  mothers  and  infants  of  Greater  Berlin.  An  example 
of  an  institution  providing  care  for  mothers  and  babies  that  is 
under  other  than  City  control,  but  still  not  wholly  private,  may 
be  of  interest.  For  work  supported  by  the  State  of  Prussia,  the 
great  Charity  Hospital  on  Schumannstrasse  stands  foermost. 
This  hospital,  under  the  direction  of  the  University  of  Berlin, 
and  serving  as  a  school  for  medical  students,  as  well  as  a  pub- 
lic benefit  and  scientific  center,  cared  for  1652  patients  in  its 
Maternity  Division  in  1920.  The  patients  pay  small  sums.  A 
clinic  is  held  weekly  for  pre-natal  advice.  The  hospital  is  old, 
and  the  equipment  not  of  the  best;  for  instance^  the  delivery 
room  is  for  eight  women  but  "Die  "Wissenshaft"  is  unexcelled. 
The  Children 's  Ward  of  the  Charity  provides  one  hundred  beds 
for  infants  under  one  year. 

As  an  example  of  work  supported  and  supervised  by  one  of 
Prussia's  twelve  provinces,  is  the  School  for  Midwives  at  Neue 
Koln  in  Greater  Berlin. 

There  are  two  private  institutions  in  Stockholm,  and  one 
semi-private  institution,  which  are  doing  excellent  work  and  may 
be  studied  as  valuable  models  even  though  they  are  not  public 
property  at  present. 


34 


Public  Maternity  and  Infant  Care 

The  Engelbrekt  Day  Nursery  and  Housekeeping  School, 
founded  in  1910,  and  governed  by  a  Board  of  Women  Trustees, 
has  its  home  in  a  modest  wooden  house  at  102  Valhallavagen,  a 
point  within  easy  walking  distance  of  the  inhabitants  of  Engel- 
brekt parish,  which  contributes  generously  to  the  support  of  the 
home,  paying  about  5000  crowns  a  year.  The  city  contributes 
10,000  crowns  a  year,  2,000  more  crowns  are  received  annually 
in  gifts,  and  the  remainder  of  the  total  annual  running  cost  of 
about  4,000  crowns,  is  met  by  the  fees  charged  the  students  in 
the  school,  and  fees  charged  for  the  care  of  the  children,  along 
with  other  funds  raised  by  various  committees. 

The  house  accommodates  twenty  infants,  thirty-five  chil- 
dren between  two  and  seven,  thirty-six  students  and  six  teach- 
ers. The  children  are  kept  from  seven  a.  m.  to  six  p.  m.  and  are 
charged  50  ore  a  day  per  child  from  the  Engelbrekt  parish. 
Children  coming  from  outside  of  the  parish  must  pay  a  little 
more.  The  children  are  under  the  medical  supervision  of  a  vis- 
iting doctor  who  in  addition  to  the  general  care  of  the  children 
prescribes  all  milk  formulas  for  infants.  The  bottles  are  made 
up  at  the  nursery  and  taken  home  at  night  by  the  mother.  No 
iH  children  are  received,  and  the  students  are  submitted  to  a 
thorough  medical  examination  before  they  are  permitted  to  take 
the  course  which  necessitates  the  handling  of  the  infants. 

Children  are  ordinarily  sent  to  the  nursery  either  by  the 
Parish  Poor  Law  Board,  the  Parish  Pastor,  the  Parish  Sister,  or 
the  Public  Guardian.  All  mothers,  to  enter  their  children,  must 
show  a  certificate  that  they  are  in  need  of  the  kind  of  care  the 
nursery  offers,  signed  by  the  Parish  Clerk. 

The  girls  who  work  at  the  Engelbrekt  School  learn  the  es- 
sentials of  housekeeping  and  baby  care,  and  for  the  course  pay 
70  crowns  a  month.  The  courses  are  from  five  to  ten  months  in 
duration,  after  the  completion  of  which  positions  are  found 
readily  for  the  graduates. 

The  advantage  of  this  combination  Training  School  and  Day 
Nursery,  over  the  day  nursery  as  it  is  known  commonly  in  the 
American  community,  is  that  the  children  supply  the  material 
for  the  schooling  of  girls  in  the  proper  methods  of  how  to  care 
for  the  young  child.  This  plan  has  worked  out  very  satisfac- 
torily in  Stockholm,  and  the  nurses  trained  in  such  institution?^ 
are  in  demand  as  trained  child  nurses.  The  teachers  are  experi« 
enced  in  domestic  science,  and  the  principles  of  hygienic  child 
care,  and  the  attending  doctor  gives  instruction  as  he  examines 


Public  Maternity  and  Infant  Caee 

the  children  and  prescribes  formulas  and  diets.  In  this  way  the 
students  become  proficient  in  general  housework,  including  sim- 
ple cooking,  and  primarily  in  nursing  well  children. 

A  somewhat  similar  plan  has  been  developed  by  the  private 
Society  for  Child  Welfare.  This  Society  has  laid  emphasis  on 
the  need  of  a  more  widespread  understanding,  on  the  part  of 
mothers  and  nurses,  of  the  proper  care  of  the  well  child.  It  con- 
sists of  about  six  hundred  interested  members,  who  pay  dues  and 
contribute  gifts  of  money.  The  Society  was  founded  in  1897 
and  is  managed  by  a  Board  of  Trustees.  Dr.  Fiirstenberg,  a 
children's  specialist,  is  the  leading  spirit  of  the  organization. 

The  home  for  babies,  maintained  by  the  Society,  well  situ- 
ated at  Kungsholmen  in  an  open  section  of  the  city,  was  built  in 
1916,  and  is  up  to  date  in  every  respect  as  to  scientific  equip- 
ment. It  has  room  for  forty-three  babies,  five  or  six  mothers 
who  are  nursing  their  infants,  and  twenty-four  young  women 
who  remain  in  the  house  four  months  for  a  course  in  baby  care. 
The  unique  feature  of  this  Home  is  that  only  healthy  infants  are 
taken.  The  object  of  the  society  is  in  the  main,  to  train  young 
women  as  nurses  for  normal  babies,  or  as  capable  prospective 
mothers.  It  is  quite  usual  indeed,  for  young  women  who  are 
engaged  to  be  married,  or  who  expect  some  day  to  be  engaged  to 
be  married,  to  take  this  four  months  training  in  the  Home.  The 
girls  pay  125  crowns  a  month  for  the  course,  and  the  infants, 
many  of  whom  are  sent  in  and  paid  for  by  the  Poor  Law  Auth- 
orities, are  charged  at  the  rate  of  3.50  crowns  a  day.  The  cost 
to  run  the  house  is  300  crowns  a  day.  Dr.  Furstenberg  acts  as 
non-resident  supervisor  of  the  home,  and  teacher  of  the  young 
women.  A  head  nurse  is  in  charge  of  the  household  arrange- 
ments and  oversees  this  part  of  the  students'  training. 

The  social  significance  of  this  exemplary  little  private  in- 
stitution is  its  independent  position  as  a  criterion  for  the  most 
scinetific  methods  of  care  for  the  well  baby.  It  is  essentially 
practical. 

"An  institution  remarkable  of  its  kind  is  the  "Little  Ones 
Home,"  opened  in  1900.  At  present  thirty-seven  children  are 
received  into  this  refuge  burdened  with  sj^philis,  and  by  the 
anxious  attention  bestowed  upon  them,  it  is  hoped  that  they  may 
be  saved  future  suffering,  prevented  from  propagating  the  com- 
plaint, and  rescued  for  useful  work  in  society.  Thanks  to  Pro- 
fessor Edward  Wellander,  Sweden  is  here  doing  pioneer  work 

36 


Public  IVIaternity  and  Infant  Care 

in  this  regard.*"  Profesor  Wellander  founded  this  Home  and 
provided  a  capital  fund  from  the  interest  of  which  it  is  today- 
supported.  The  home  located  in  Kungsholmen  near  the  Home 
of  the  Society  for  Child  Welfare,  can  accommodate  fifty  chil- 
dren who  enter  at  four  months  of  age,  if  a  Wasserman  test  has 
proven  positive,  and  remain  until  four  years  of  age.  During 
this  period  intensive  treatment  is  given.  All  the  children  who 
have  in  the  past  left  the  home  have  been,  temporarily  at  least, 
freed  from  the  disease.  One  trained  nurse  and  ten  assistants 
do  the  work  in  the  house. 

The  children  are  usually  illegitimate,  and  at  the  end  of 
their  stay  in  the  Home  are,  if  not  wanted  by  their  mothers,  taken 
over  by  the  Poor  Law  Authorities.  Children  may  enter  the 
Home  from  any  source  whatsoever.  They  may  be  members  of 
families  of  any  degree  of  wealth,  but  usually  are  the  offspring 
of  Stockholm's  less  fortunate  social  element.  Statistics  for  the 
Home  as  given  in  Stockholm 's  Report  of  the  City  Health  Board 
for  1919  are  :— 

PATIENTS 

Number  of  beds  occupied  at  the  beginning  of  year    46 

Entered      16 

Deaths    5 

Days  kept 13,047' 

Total  cost  in  crowns 38,065.25 

******* 

The  Swedish  institutions  that  have  been  described  above 
have  been  selected  as  types  of  the  work  in  maternity  and  infant 
care  done  by  and  for  Stockholm's  public.  They  have  proven 
themselves,  without  exception,  impressive  in  their  character  of 
individual  efficiency  and  economy.  There  is  one  obvious  criti- 
cism  which  the  preceding  study  brings  forth,  namely,  the  de- 
centralization of  work  done  for  children  and  infants.  As  sug- 
gested before,  a  foster-infant  may  be  supervised  by  the  Board 
for  Child  Welfare,  inspected  by  the  Board  of  Health,  and  in  re- 
ceipt of  relief  from  the  Poor  Law  Board,  in  which  case  it  is  ob- 
viously possible  that  much  overlapping  of  effort,  and  conflict 
of  authority  could  occur.  The  responsibility  rests  in  three  de- 
partments with  the  consequent  danger  of  waste  and  missed 
cases  that  is  difficult  to  avoid  in  such  a  system.  That  such  has 
not  been  more  conspicuously  the  case  is  due  to  the  honesty  and 

*  By  M.  Blumental  in  Guinchard's,  "Sweden,  Land,  and  People." 

37 


Public  Maternity  and  Infant  Care 

care  of  the  officials  in  charge  of  Stockholm's  puMic  work.  The 
lack,  moreover  of  centralized  authority  and  responsibility,  is 
recognized  by  those  prominent  in  public  social  office  in  Sweden. 
To  remedy  the  condition  a  Royal  Commission  has  been  at  work 
and  their  report,  which  was  due  to  appear  in  the  spring  of  1921, 
will  recommend  important  changes,  the  crux  of  which  will  rest 
in  making  the  Board  for  Child  Welfare  the  central  and  supreme 
authority  for  the  public  care  of  needy  children.  The  work  done 
by  the  Department  of  Education  for  the  relief  of  public  school 
children  will  run  parallel  to  this  converted  Board  of  Child  Wel- 
fare. The  change  cannot  be  wrought  before  1923,  but  at  that 
time  those  interested  may  find  the  condition  worthy  of  study. 

The  problem  in  Berlin  is  its  vastness,  and  with  the  present 
complications  of  limited  public  and  private  funds,  plus  extreme 
hardship  for  those  of  insufficient  income,  the  problem  is  even 
more  difficult  than  ordinarily. 

One  of  the  most  encouraging  signs  in  Berlin  is  that  the  Poor 
Law  Board  exists  no  more,  and  in  action  its  successor,  as  far  as 
concerns  the  work  for  mothers  and  infants,  is  concerned  in  a  co- 
operative capacity.  This  condition  eliminates  the  factor  that 
tends  most  to  divide  and  decentralize  the  present  work  in  Swed- 
en. Furthermore,  the  supervision  of  the  Board  of  Health  is  so 
designed  as  not  to  overlap  the  province  of  the  Department  for 
the  Welfare  of  Children. 

A  marked  characteristic  of  the  work  in  Berlin  is  that  it  is 
distinctly  of  an  educational  or  constructive  nature.  Pre-natal 
clinics,  propaganda  for  proper  care  during  pregnancy,  confine- 
ment, and  through  the  nursing  period,  the  concentrated  respon- 
sibility for  foster  children,  and  the  National  Mothers'  Pensions, 
indicate  the  fact  that  Berlin  has  long  since  distinguished  be- 
tween "Relief,"  and  that  which  is  decidedly  "Treatment  and 
Cure." 

The  concept  of  one  central  agency  dealing  with  all  needy 
children  has  been  planned  admirably  in  the  Berlin  Department 
for  the  Welfare  of  Children. 

The  successful  carrying  out  of  a  policy  of  extensive  public 
service  depends  in  large  measure  upon  the  efficient  and  eco- 
nomical utilization  of  the  resources  at  hand,  by  State  and  Muni- 
cipal governments.  And  as  one  travels  between  institution,  and 
supervising  authority,  one  is  impressed  in  Germany  and  Swe- 
den with  the  honest  use  of  public  funds;  workmanlike  offices 

38 


Public  Maternity  and  Infant  Care 

for  the  fewest  possible  officials.  Everywhere  there  is  evidence 
of  a  strict  economy  in  overhead  with  a  corresponding  benefit  to 
the  institutions.  The  public  money  is  invested  obviously  in  ex- 
penditures of  real,  not  doubtful  value. 


NOTE 

For  a  satisfactory  and  comiprehensive  ibilbliograjphy  on  the  sub- 
ject of  Maternity  and  Infant  Care,  see  "Bibliography  on  the  Care  and 
Feeding  of  Infants  and  Children,"  issued  by  the  Bureau  of  Child  Hy- 
giene of  the  New  Jersey  State  Department  of  Health. 


I7NlyEESITr  OF  CALIFORNIA  LIBBAET 

BERKELEY  ^^^x, 

THIS  BOOK  IS  DUe"Tn  the  LAST  DATE 
STAMPED  BELOW  ^ 

50c  prr'Utl1dhe""htT/^^  ^"''^'-^  ^  a  fine  of 
Jf£il!!!^l.fiifi£n  pen^Td      ^PP^'^ation  is  made  before 


JUN  1     1946 

DEC     4    1946 
^^^    5    1947 


50jn-7,'29 


iUI«AR) 


y 


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